Partial laser arytenoidectomy in the management of bilateral vocal fold immobility. A modification nased on functional anatomical study of the cricoarytenoid joint

To establish the anatomical relationships of the arytenoid and cricoid cartilages and apply these findings to design an arytenoidectomy based on a sound anatomical basis. We prospectively conducted this study between 1996 and 2002 at the Main University Hospital of Alexandria, Egypt. In 50 patients, we endoscopically measured the length of the vocal process and the distance between the vocal process tip and upper border of the cricoid cartilage. We sagittally and axially sectioned 25 total laryngectomy specimens to verify the position of the arytenoids and their relation to the cricoid. The anatomical findings led to the design of a laser partial arytenoidectomy and cordotomy [L-PAC], which we used in 45 patients with bilateral cord paralysis in adduction. The anatomical findings showed that the cricoarytenoid joint did not contribute to the airway in any of the measured specimens. Using L-PAC, we decannulated 100% of the patients and no patient needed postoperative tracheostomy at any time. Only 3 patients experienced minimal postoperative aspiration to liquids [6.7%]. We achieved reasonable phonation as assessed by a speech analysis battery. However, 3 patients [6.7%] needed contralateral L-PAC. The present extra-articular technique, L-PAC, showed its superiority to previous endoscopic or transcervical complete arytenoidectomy techniques in providing an effective balance between the protective, respiratory, and to a lesser extent the phonatory functions

role of bronchoscopy versus fluoroscopy in diagnosing persistent stridor in infants and children

Stridor is a high pitched respiratory sound usually inspiratory, but may be expiratory or biphasic produced by turbulent airflow due to partial airway obstruction at the level of the pharynx, larynx and/or trachea. Stridor can be classified into two types: acute stridor and persistent or chronic stridor. Evaluation of child with persistent stridor includes radiological assessment mainly plain X-ray and fluoroscopy. Direct visualization of the airway is often necessary to confirm the diagnosis and is essential in children with persistent stridor. The aim of this study was to determine the role of flexible fiberoptic and rigid bronchoscopy in comparison with fluoroscopy in diagnosing the site of partial upper airway obstruction in infants and children with persistent stridor. The study was conducted on 35 infants and children presented by persistent stridor. Fluroscopy and bronchoscopy [Flexible or rigid] were done for all the cases. The results obtained from fluoroscopy were compared to those obtained from bronchoscopy. The most common type of stridor was inspiratory in 80% of cases followed by biphasic stridor [11.4%], and lastly, the expiratory stridor [8.6%]. The most common cause of stridor in the studied group was Laryngomalacia in 17 cases [48.6%]. Flexible and rigid endoscopy were able to diagnose the site as well as the pathology in 35/35 of studied cases [100%]. Fluoroscopy delineated the site of obstruction in 4/35 cases [11.4%], two cases had external compression by vascular ring, one case of subglottic stenosis and one case with congenital tracheal stenosis. This study demonstrated the usefulness and safety of bronchoscope either flexible or rigid, in infants and children with persistent stridor. It usually provides rapid and precise diagnosis without significant complications. Diagnostic radiological modality as fluoroscopy needs more improvement. It may serve as a cost-effective screening tool in the evaluation of stridor in children, especially for lesions of the lower airway

Head and neck lipomas: presentation variability

Head and neck lipoma has seldom drawn attention in the literature except for separate case reports. Study presentation variability of head and neck lipomas as well as relative importance and efficiency of preoperative diagnostic methods used. Patients diagnosed as having head and neck lipomas presented to the Otolaryngology-Head and Neck Surgery Department, Alexandria Faculty of Medicine were included in this study. Preoperative clinical, laboratory and radiological evaluation was conducted peroperatively. Surgical excision was done and postoperative histopathological examination confirmed the diagnosis. Twenty-four patients had 26 lipomas. Males predominated [62.5%]. The posterior subcutaneous neck was the most common site. Three patients had deep lipomas affecting the hypopharynx, larynx and parotid gland; all were correctly diagnosed preoperatively. Computed tomography [CT] scans with specific radiodensity recording was the preferred preoperative investigation. Lipomas should be considered in the differential diagnosis of soft-tissue head and neck masses even in rare locations. CT or magnetic resonance imaging [MRI] scans can accurately diagnose a lipoma preoperatively thereby allow for better treatment planning

Laparoscopic cholecystectomy: evaluation with sonography

Fifty patients underwent laparoscopic cholecvstestomy [36 females and 14 males] their ages ranged between 29-50 years. All the patients were subjected to sonographic examination pre-operatively for evaluation of gall bladder and common bile duet stones all patients were subjected to postoperative sonographic examination 24 hours after laparoscopic cholecystectomy. The location, volume and appearance of fluid collections were recorded, the maximam diameter of the common duet was measured in all patients and compared with the pre-operative measurement. In our series one patient with a common bile duct stone was seen at sonography and the stone was removed by endoscopic sphincterotomy prior to laparoscopic cholecystectomy. In 9 cases the gall bladder was perforated during the technique with spillage of bile, stons or both. There was a lost surgical clip in one case and bleeding occurred in one case from the gall bladder bed. 18 cases developed fluid collection 20 ml and 8 cases developed fluid collections. 20ml but all were of no clinical importance. In 10 of 50 patients, the diameter of common bile duct had increased on the post- operative scan. In two of them it was associated with elevation of liver chemistry profiles, a 5 mm stone was found in one case after one month and the other case presented with abdominal pain which subsided spontaneously after 48hrs. 47 patients [94%] were discharged the day after surgery and the average time to return to work was 4-8days

Maxillary sinus affection in cases of rhinoscleroma [Radiology versus sinuscopy]

Twenty patients diagnosed clinically and histopathologically to be rhinoscleromatous were examined radiologically, endoscopically and biopsies from the antra were taken through the sinuscope. The correlation between the radiological and endoscopic findings revealed that radiology alone was not satisfactory in diagnosing sinus affection by rhinoscleroma, while sinuscopy was an excellent mean for the visualization of sinus and the determination of the exact location and extent of the lesion and also provided an exact histopathological diagnosis of scleroma in 25% of the cases